Applications to medical schools in the United States have fallen by a fifth in the past four years, new figures from the Association of American Medical Colleges (AAMC) show. US medical schools had 37 137 applicants for the 16 303 places available for entry in 2000, a fall of 3.6% from last year.

UK medical school applications also began to fall despite the government's pledge to create 1000 additional student places for medicine. Figures from the UK's Universities and Colleges Admissions Service (UCAS) show that in the UK there were 10 972 applicants for the 5454 places available, falling from 12 078 applicants in 1997. Figures just released by the service show that there has been a 3.2% drop in applications for medicine compared with the same time last year, similar to American figures. The complete figures for the UK 2001 entry will not be available until late next year.

Michael Powell, speaking on behalf of the Council of Heads of Medical Schools in the UK, said that although there was a relatively small reduction in the number of applicants, he saw no reason for it to continue. He attributed the decline to a combination of reasons, including better advice from schools and a greater realism about chances of a successful application.

Although applications fell, the number and quality of students entering medical schools continued to climb in both countries. There are still more than two applicants for each available place.

Dr Donald Thomson, the associate dean responsible for undergraduate admissions at Edinburgh University, confirmed that there had been a drop in applications. Although he warned against complacency, he felt that the minor fall should be put in the context of medical school expansion and a continuing oversupply of suitably qualified candidates. At Edinburgh applications fell by 24% last year, but this was mainly due to a change in application procedures.

The AAMC identified the strong economy, perceived loss of physician autonomy, backlash against affirmative action, and concern over student debt as among the culprits. Adverse publicity from high profile cases, such as that of Harold Shipman, the UK GP who was convicted of murdering 15 of his women patients, has also been blamed in both countries. The association was encouraged, however, by the small rise in applications from underrepresented minorities, which now constitute just over 11% of applicants. Figures from UCAS show a similar figure of 10% for medicine and dentistry in 1998.